Problems plague federal drug plan
December 30, 2005
Many Nevadans have not been able to access government-subsidized prescription drugs in the new Medicare program. Instead, they are coming home from the pharmacy empty-handed and frustrated.
After its first week in use, local pharmacists said many Medicare participants have not received their plastic identification cards needed to bill the plan provider for the prescription drug.
Thousands of Nevada’s mentally disabled are getting their medications for free from the state until the problems with the federal prescription drug program are fixed, a state mental health pharmacy director said.
“We don’t have a choice but to do it,” said Dr. Emmanuel Ebo, statewide pharmacy director for Mental Health and Development Services. “We don’t want our patients to decompensate or to be readmitted. We’ll worry about the reimbursement later.”
He said these patients have moderate-to-severe mental disabilities and cannot be out in the community without medications. Ebo said no one knows how much this will cost. It was not budgeted because the problem was not expected. He doesn’t know when the new plan will work for the thousands of mentally ill and disabled clients who are on both Medicare and Medicaid.
The Medicare participant must pay out-of-pocket for expensive drugs, or wait until the start-up problems are ameliorated.
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That means Pauline and George Bauman, both 85, are waiting patiently to fill prescriptions.
Pauline Bauman, who lives on a fixed income with her husband in Gardnerville, hasn’t even gotten herself set up with a prescription drug plan. She only takes two pills a day. Her husband is the priority because he takes 11 medications a day.
She got help deciphering Medicare Part D, the prescription drug benefit, from friends and an expert at the Douglas County Senior Center. Three weeks ago, she mailed the application for her husband to enroll with First Health Premier, a private insurer that operates one of the prescription drug plans.
“So far I’ve received a letter saying that his application is under consideration,” Bauman said. “But he hasn’t received his card, only an identification number. I went to Smith’s pharmacy yesterday with three prescriptions that I need filled. Smith’s couldn’t get through to the company to get them to fill it. Today, I’ve been trying to get through to the company. I haven’t been able to get through.”
She has to have the medication by the middle of this week, when her husband will run out of his supply.
“Or we will have to pay full price,” Bauman said.
Full price for eight of his medications is $700 a month. Once their new plan is working, prescription drugs should only cost them $140 a month.
“They’re not getting their cards,” said pharmacist Mike Hautekeet, who owns Mike’s Pharmacy on Curry Street. “If they don’t have their cards, we can’t figure out where they’re insured. There is a number you can call and they will confirm if the patient is insured, but they don’t tell you where because of the privacy laws.”
The patient then calls Medicare and waits on the phone for as long as 30 minutes, he said.
Pharmacist Kirk Wentworth, who owns Medicare Pharmacy on North Carson Street, said he has had little luck getting through to a plan provider. Sometimes, they just hang up on him.
“I’ve been working nine to 10 hours a day this week, and I’ve hired another pharmacist at $250 a day to handle the transition,” Wentworth said. “I hope it gets better because I don’t know if I can afford it. And with this new program, no way.”
He is running about 20 of the new Medicare cards a day, but mostly he works off an acknowledgment letter sent to the patient by the plan provider.
A Medicare spokesman recommends participants who have not received their cards to bring this letter to their pharmacy. Or the person can call his or her plan provider and have them fax the letter to the pharmacy.
Many people are paying cash and hoping for a reimbursement once the kinks are worked out of the system.
“Low-income people and the elderly are going to suffer because the system is so complicated and nobody has a clue what’s going on,” Hautekeet said.
So far, 17,000 disabled and elderly Nevadans have converted to the fed’s new prescription drug program, said Charles Duarte, administrator of the state Division of Health Care Financing and Policy.
In just a week, the problems are mounting.
When a pharmacy accesses the federal database, it receives flawed data.
Dual Medicare and Medicaid beneficiaries were supposed to be auto enrolled by the government into a plan.
“We have about 500 or so who look like right now that they weren’t,” he said. “What we’re seeing on a national level, and affecting us locally, are pretty significant start-up problems.”
Pharmacies should be able to ask Medicare which plan the patient is enrolled in. All of last week, Duarte talked to pharmacists who say they can’t get through. Is this because of privacy laws?
He laughed. The administrator hasn’t heard that excuse yet. That shouldn’t be happening.
The outcome: the disabled and elderly are not able to buy their prescriptions with the benefit plan.
“The feds need to make a statement that they’ll assure pharmacies will get reimbursed, and that people will get reimbursed for out-of-pocket,” Duarte said. “They should just eat crow.”
The feds are putting much of the blame on a year-end enrollment surge that jammed the database. Many Medicare participants wanted to get in before the program began on Jan. 1, said Jack Cheevers, Medicare spokesman in the regional office in San Francisco.
A pharmacy hotline number was passed on to state and national pharmacy trade associations and to the state boards of pharmacy for pharmacists to access for billing information.
“We just added 4,500 customer service reps to the 150 who were staffing the pharmacy hotline,” he said. “We believe this added manpower will make it significantly easier for pharmacists to get the eligibility information they need, and for their customers to get their prescriptions promptly filled.”
Wentworth, a pharmacist in Carson City for almost 25 years, said the confusion will pass.
“The initial phase is always difficult,” he said. “I think it will smooth out. The program pays 75 percent of the first $2,000 they spend, so the benefit outweighs the hassle.”
n Contact reporter Becky Bosshart at email@example.com or 881-1212.